Friday, July 31, 2015

A study published this week in the journal Radiology suggests that subtle differences in regional brain volumes that appear to be related to cardiovascular risk factors may potentially serve as an early indicator of cognitive decline before the onset of dementia.

Researchers from the Keck School of Medicine at the University of Southern California, Los Angeles, analyzed data from 1,629 participants in the Dallas Heart Study, aged 25 to 73, to investigate modifiable cardiovascular risk factors (alcohol consumption, smoking, diabetes, and obesity) associated with regional brain volume changes and their association with preclinical deficits in cognitive performance. Participants’ cardiovascular risk factors were evaluated in an initial baseline visit; brain volumes and cognitive function were assessed seven years later by, respectively, magnetic resonance imaging and the Montreal Cognitive Assessment (MoCA).

The results showed that alcohol consumption and diabetes were associated with smaller total brain volume, while smoking and obesity were associated with reduced volumes in the posterior cingulate cortex. Lower hippocampal volume was associated with previous alcohol consumption and smoking, and lower precuneus volume correlated with alcohol consumption, obesity, and high fasting blood glucose numbers.

Low total scores for MoCA were associated with reduced posterior cingulate volume in participants under 50 and with reduced hippocampal and precuneus volumes in those 50 and over.

“Our findings reveal that lower total brain, hippocampal, precuneus, and posterior cingulate volumes are associated with cardiovascular risk factors and with impaired cognitive performance before the onset of clinical dementia. … even in participants younger than 50 years,” the researchers noted. They concluded that subtle differences in regional brain volumes in midlife may serve as a biomarker for brain insult before the onset of dementia.

Thursday, July 30, 2015

The Food and Drug Administration today issued a warning to health care professionals and patients concerning reports of confusion between the antidepressant Brintellix (vortioxetine) and the anti-blood clotting medication Brilinta (ticagrelor), which has resulted in the wrong medication being prescribed or dispensed.

The FDA has determined that the main reason for the confusion between the two medications—with extremely different indications—is the similarity in the marketed names of the drugs. While Brintellix is used to treat major depressive disorder, Brilinta is used to lower the risk of recurrent heart attacks or death from a heart problem after a heart attack or severe chest pain.

To reduce the risk of name confusion, the FDA recommends that health care professionals include the generic name of the medication (e.g., vortioxetine) in addition to the brand name and the indication for use when prescribing the medication. The FDA also recommends that patients check their prescriptions to ensure that the correct medication was dispensed.

Thus far, no reports made to the FDA regarding the name confusion have indicated that a patient has ingested the wrong medication; however, the agency announced that reports of prescribing and dispensing errors continue.

The ability to firmly diagnose schizophrenia before symptoms of the disease arise can help improve patient outcomes by reducing periods of untreated psychosis. In a paper recently published in Translational Psychiatry, Sabine Bahn, M.D., Ph.D., of the University of Cambridge and colleagues describe the development of a biomarker test for the identification of individuals at risk of developing schizophrenia based on multiplex immunoassay profiling analysis of 957 serum samples.

The researchers first conducted a meta-analysis of five independent cohorts comprising 331 first-onset drug-naive schizophrenia patients and controls to establish a diagnostic serum biomarker panel, which led to the identification of 26 biomarkers that best discriminated patients and controls. Next, they evaluated the diagnostic performance of the 26-analyte panel using samples from two independent cohorts comprising 93 patients diagnosed with first- or recent-onset schizophrenia and 88 controls, which yielded an area under the curve (AUC) of 0.97 (sensitivity=87%, specificity=97%, accuracy=93%) for schizophrenia detection. Lastly, the researchers tested the predictive performance of the panel before onset of psychosis using two cohorts of 445 pre-onset or at-risk individuals.

According to the authors, “The predictive performance achieved by the panel was excellent for identifying U.S. military personnel (AUC: 0.90 [0.86–0.95]) and help-seeking prodromal individuals (AUC: 0.82 [0.71–0.93]) who developed schizophrenia up to two years after baseline sampling. The performance increased further using the latter cohort following the incorporation of CAARMS (Comprehensive Assessment of At-Risk Mental State) positive subscale symptom scores into the model (AUC: 0.90 [0.82–0.98]).”

While the authors acknowledged that further validation studies using larger independent pre-onset sample sets are needed, they wrote, “[t]he biomarker panel presented here represents a validated set of biomarkers from which a definitive signature for diagnosis and prediction of schizophrenia in the clinical setting could be developed. Ultimately, further developments of the biomarker panel could form the basis of a low-cost blood test, which can complement DSM-5- or ICD-10-based diagnostic approaches.”

Wednesday, July 29, 2015

Being socially well integrated appears to lower the risk of suicide in women, according to a study published online today in JAMA Psychiatry.

To examine the association between social integration and suicide, Alexander Tsai, M.D., Ph.D., of Massachusetts General Hospital and colleagues analyzed data from 72,607 women participating in the Nurses’ Health Study who were surveyed about their social relationships from 1992 to 2010. Social integration was based on a seven-item scale covering “marital status, social network size, frequency of contact with social ties, and participation in religious or other social groups.”

Overall, there were 43 suicides during 1,209,366 person-years of follow-up—a rate the authors noted is lower than suicide rates nationally. After adjustment for age and other variables, the authors determined that women with the highest level of social integration had a hazard ratio for suicide of 0.23 versus 1.0 for women recording the lowest level of social integration.

“Our study strongly suggests that social integration has a protective association against suicide risk for women, even after adjustment for multiple indicators of poor mental health,” the authors wrote. “Interventions aimed at strengthening existing social network structures, or creating new ones, may be valuable programmatic tools in the primary prevention of suicide.”

“[T]he results of their study invite further research to explore whether factors or behaviors that reflect longstanding measures of individual social integration predict a person’s mindset when he or she is suicidal,” wrote Eric Caine, M.D., a professor of psychiatry at the University of Rochester, in an accompanying editorial.

Tuesday, July 28, 2015

Physical activity appears to be inversely related to sadness and suicidality in adolescents and may be protective against suicidality in adolescents who are bullied, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

Using the 2013 National Youth Risk Behavior Survey (N=13,583), researchers from the University of Vermont analyzed the effect of physical activity on odds ratios for sadness, suicidal ideation, and suicide attempts according to whether students were bullied.

Overall, 30.0% of students reported sadness for at least two weeks, 22.2% reported suicidal ideation, and 8.2% reported suicide attempts in the previous 12 months. Bullied students were twice as likely to report feeling sad and three times as likely to report suicidal ideation or attempts.

But students who reported exercising four to five days per week had lower adjusted odds of sadness, suicidal ideation, or suicide attempts than students who exercised one day or less each week. After stratifying by bullying, similar but slightly weaker associations were observed. Overall, exercise for four or more days per week was associated with an approximately 23% reduction in suicidal ideation and attempts in bullied students.

“The consequences of bullying are well described, yet little is known about protective factors that may diminish the negative sequelae,” the researchers stated. “One possible factor, physical activity, improves mental health in general and clinical populations....We hypothesized that physically active students would be less likely to feel sad or report suicidal ideation or attempts, including bullied students."

Monday, July 27, 2015

A study presented at the 2015 Alzheimer’s Association International Conference, held last week in Washington, suggests that frequencies of physical activity and television viewing in early adulthood may impact cognitive function in midlife.

To investigate whether an association exists between long-term patterns of low physical activity and high television viewing time in early adulthood and cognitive decline in midlife, Kristine Yaffe, M.D. (pictured left), the Roy and Marie Scola Endowed Chair and Vice Chair of Research in Psychiatry at the University of California, San Francisco, and colleagues analyzed data of more than 3,200 individuals, aged 18 to 30. The physical activity and television viewing of the participants were assessed at three or more visits over 25 years. At year 25 of the study, the researchers assessed the participants’ memory, executive function, and processing speed. The investigation was a part of the Coronary Artery Risk Development in Young Adults study.

The researchers found that participants who reported low physical activity (less than 300 kcal/50 min session, three times per week) in more than two-thirds of the follow-up visits had significantly worse cognition in midlife than individuals reporting less frequent physical inactivity—even after adjusting for education, smoking habits, alcohol consumption, body mass index, and hypertension. Participants who reported regularly watching television for more than 4 hours per day throughout the study also had worse midlife cognition than those who reported less television viewing. Those who reported a history of long-term low physical activity and high television viewing were almost two times more likely to have poor cognitive function in midlife.

The researchers said that because global data suggests that levels of physical inactivity and sedentary behavior are increasing, understanding the relationship between physical activity in early adulthood and cognitive decline later in life may be of importance. They concluded that because research indicates that Alzheimer's disease and other dementias develop over several decades, increasing physical activity and reducing sedentary behavior beginning in early adulthood may have a significant public health impact.

Friday, July 24, 2015

Attention-control training is more effective than attention-bias modification at reducing the symptoms of posttraumatic stress disorder (PTSD), according to a study published today in American Journal of Psychiatry in Advance.

Attention-bias modification is designed to shift attention away from perceived threat, whereas attention-control training aims to balance attention between threat and neutral stimuli.

This study compared these two attention strategies in two groups of veterans: one in Israeli Defense Forces veterans and the other in U.S. military veterans. The protocol involved computerized tests focusing the participants’ attention on either neutral or aggressive words.

In both groups, the attention-control training was far more effective in reducing both self-reported and clinician-reported PTSD symptoms in the participants. Attention control, but not attention-bias modification, also reduced the participants’ variability in their attention bias, which is how much they shifted their attention toward or away from threat within a training session.

When the results of both training sessions were combined, the analysis showed that this normalization of attention variability was at least partially responsible for the related improvements in PTSD symptoms. Thus, the authors suggested that balancing these moment-to-moment attention shifts from threat vigilance to threat avoidance may be a preferred treatment strategy.

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